Like Dogan, Howard agreed that the SAD diet is flawed and overrates the
importance of grains, noting that many people have an intolerance to gluten.

"It contains things that your body doesn't need, like hydrogenated oils and
trans fats," Dogan said, adding that the foods are packed with chemicals,
preservatives and too much salt.

Howard and Dogan offered insight into other healthier diet choices.

Howard's goal for his program is a sustainable weight loss, and he uses the
Aggregate Nutrient Density Index Score as a nutritional guide. This diet
encourages eating the highest amount of the most highly-nutritious foods.

For instance, foods such as spinach and kale are at the top of the scale and
caloric dense foods such as soda are at the bottom.

"They can eat a high volume of food, but not intake the calories," Howard said.

Volumetrics refers to foods that can be eaten in infinite amounts without weight
gain, Howard said, adding that eating your weight in kale and spinach could be
done without having a caloric problem.

"You can eat a lot of food until you have that full feeling," Howard said.

According to Howard, his program increases the amount of fruits and vegetables,
decreases caloric dense foods such as meats and dairy, and eliminates sugar.

Much like the ANDI Score, Howard said the Mediterranean diet is a healthy
choice. The Mediterranean diet and ANDI Score are similar in that they're high
in nutrition and low in calories.

Dogan said the Mediterranean diet is one of her top recommendations for not only
cardiovascular recovery patients, but for anyone who wants to make a lifestyle
change.

The diet also recommends limiting red meat to no more than a few times a month.

Dogan said the Mediterranean diet has been proven to be a good diet for
decreasing a host of chronic diseases such as cardiovascular disease, diabetes
and cancer. She said it also can promote weight loss, but like other diets,
people should avoid overeating.

"It's more of a lifestyle. It's not a structured diet," Dogan said.

Diets that cut out entire food groups -- the Paleo diet and vegetarianism -- can
be beneficial, but Dogan and Howard said there are also some drawbacks.

The Paleo diet includes meats, seafood, vegetables fruits and nuts. It is a
grain-free and dairy-free diet that mimics the caveman diet.

"I was told once to do the Paleo diet because of gastrointestinal problems and
food allergies," Dogan said. "It might work short-term to help you figure out
what grains you're allergic to, but to cut out a whole food group isn't
recommended."

Dogan said the Paleo diet might help gluten-intolerant patients get rid of the
inflammation in their GI tract and could gradually add back grains to see what
you're allergic to.

Howard said the Paleo diet is a good way to make a lifestyle change, but is hard
to sustain.

"You're going to get more nutrition because you're eating foods of a higher
quality (unprocessed foods)," Howard said.

Vegetarianism can work out to be healthy, Dogan said, adding that it's mostly a
lifestyle choice for people because of religious or moral beliefs. One problem
it can cause is eating too much junk food, she said.

Vegetarians are missing out on vitamin B-12 and creatine, Dogan said.

"Deficiencies can cause poor memory, fatigue, depression, damage to the brain
and can mimic the symptoms of multiple sclerosis," Dogan said. "Taking vitamins
can help you. The bottom line is deficiencies can cause adverse effects on brain
function."

Before selecting a diet, Howard said behavioral modification is the first step
to manage weight loss.

"What we have to do is change the behaviors that cause us to be obese," Howard
said. "We have to educate people on having the motivation to eating the right
foods and motivation toward exercise. What we normally do are the things that
cause us the most pleasure and least amount of pain."

For instance, Howard said people tend to eat food that gives them a feeling of
happiness for a moment and the behavior is repeated. Although that feeling of
happiness might be present, Howard said it would be better filled with
nutritious foods rather than caloric dense foods.

"Some people say, 'I hate exercise.' Most of the people have a reason because
they hurt themselves or because exercise is too difficult," Howard said. "A
modification would be to do something that's easy for them to do."

Howard suggested doing one push-up a day or walking a quarter of a mile for
seven days.

Although weight loss is a personal goal, Howard said it has to incorporate the
family and community to be sustainable.

"Most people have about a 21-day tolerance for doing something out of their
comfort zone. A diet or behavioral change you can do for a long time will give
you the most sustainable results," Howard said. "If you do something you hate,
you're eventually not going to do it anymore. It's human nature."

If someone can do something every day for 21 days, it creates a habit whether it
is positive or negative, Howard said.

Dogan said the diet for each individual depends on food allergies and other
dietary restrictions.

"You always want to go back to a dietitian that might figure out what the best
path is for you," Dogan said. "Everybody is different and has different needs.
Not one eating plan or lifestyle change will fit everybody."

Regardless of the diet of choice, Dogan suggested some universal rules. The food
on the plate should be colorful like a rainbow.

"Eating whole foods -- fresh fruits and vegetables that are local, meats that
have been fed the old-fashioned way and not full of hormones and antibiotics are
good standards," Dogan said.

Leah Cayson can be reached at 256-340-2445 or leah.cayson@decaturdaily.com.
Follow on Twitter @DD_Leah.

___

(c)2014 The Decatur Daily (Decatur, Ala.)

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